Letters to health-care Santa: Nationalize the exchanges!

Over the course of this week, I'll be asking some health-care experts what they'd like Santa to add to the bill during conference committee, and publishing their responses on the blog. First up is Diane Archer, the director of the Health Care Project at the Institute for America's Future and founder and past president of the Medicare Rights Center.

The single biggest weakness in the Senate bill is its reliance on states to implement the exchanges. No one likes being told what to do, and the states are no exception when it comes to federal mandates.

The federal government should implement the law in a uniform way and relieve the states of the burden of setting up whole new insurance markets and regulatory structures--unless they choose to and demonstrate their ability to--as the House bill provides. And, we need the will, skill, resources and power of the federal government to ensure that the insurers behave. History and experience suggest the states will almost always be outgunned by the insurers. The states should hold complementary regulatory authority over the insurers and also have the right to innovate and improve the insurance market.